Treatment

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While there is no cure for Alzheimer's disease, medical treatments can help alleviate some of the behavior and cognitive symptoms.

The FDA has approved two classes of drugs to treat the cognitive symptoms of AD. Four are in a class known as acetylcholinesterase inhibitors (also called cholinesterase inhibitors). They work by inhibiting an enzyme called acetylcholinesterase which normally breaks down acetylcholine, a key neurotransmitter involved in cognitive functioning. Levels of acetylcholine typically drop sharply in patients with AD.

The fifth drug, memantine (Namenda), is classified as an uncompetitive low-to-moderate affinity N-methyl-D-aspartate (NMDA) and is approved for the treatment of moderate to severe AD. It works by blocking excess amounts of a brain chemical called glutamate that is involved in information processing, storage and retrieval.

While the drugs can't restore dead brain cells, they can slow or temporarily forestall the inevitable decline. Usually these medications are easily tolerated. However, side effects like diarrhea or loose stools, nausea, vomiting, loss of appetite and weight loss sometimes occur. Occasionally, there can be muscle cramps, increased nasal secretions or urinary incontinence. Some people may have sleep disturbances, often with strikingly vivid dreams. Approved drugs are:

• Donepezil (Aricept). This drug can help boost thinking abilities and reduce some general function and behavior problems of AD without significant side effects. It is usually taken daily at bedtime and is approved for all stages of AD.

• Rivastigmine (Exelon). This drug can help improve thinking and memory, activities of daily living and general functional abilities. It is approved for mild to moderate AD.

• Galantamine (Reminyl). This drug is approved for mild to moderate AD and can help improve cognitive symptoms of the disease.

• Tacrine (Cognex). Tacrine was the first acetylcholinesterase inhibitor approved by the FDA, but because it is very toxic to the liver, it is not used much anymore.

• Memantine (Namenda). This is only drug approved for slowing the advance of moderate to severe Alzheimer's. It appears to work by regulating the activity of glutamate, a brain chemical involved in information storage, processing and retrieval. Some common side effects include dizziness, headaches, constipation and confusion.

Although typical of AD, any changes in behavior should be reported to a health care professional so any potential physical causes may be investigated. Behavioral symptoms may be influenced by a variety of factors, including:

• physical discomfort
• side effects from medication
• chronic pain
• infection
• nutritional problems
• problems with vision or hearing
• disruptive environment
• upset or unprepared caregiver

Whenever possible, health care professionals usually try non-drug interventions first to reverse behavioral symptoms. Some medications can make behavior-related symptoms worse. Caring for someone with memory loss can be challenging, but it can be easier if you learn the right skills. The Alzheimer's Association and other community agencies can provide family members with the education necessary to become successful caregivers.

Nondrug treatment options include:

• Change the mood of the home environment:

  The lighting in a house or apartment, colors in the decor and level of noise in the immediate living area can have a significant impact on how someone with AD behaves and feels. Researchers found that certain types of lighting can make some people feel uneasy, while higher noise levels can induce frustration.

• Create a routine and stay active:

  Constructing a routine for everyday activities including dressing, bathing and cooking can reduce depression and help keep someone with AD active longer. It may also reduce the chances of wandering because the person is more likely to follow the daily routine. Alzheimer's experts also recommend patients take up creative and pleasing activities that can bring more happiness into their life, such as painting, reading or singing.

Research is currently under way to find additional medications that can help relieve the more intense behaviors associated with AD. For now, other drugs are used to treat symptoms such as agitation, aggression, delusions or depression, including:

• Antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), and haloperidol (Haldol) address delusions, hallucinations, aggression, uncooperativeness and hostility.

• Anxiolytics such as oxazepam (Serax) and lorazepam (Ativan) help calm anxiety and agitation. Only the short-acting types are typically prescribed for AD patients and should be used intermittently, not regularly.

• Antidepressants, including citalopram (Celexa), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft) and others for low mood and irritability. Note: All antidepressant drugs now contain a "black box warning" stating that anyone who starts therapy with these drugs—particularly children and adolescents—should be watched closely for clinical worsening, suicidal tendencies or unusual changes in behavior.

Some people with Alzheimer's use alternative treatments such as herbal remedies and dietary supplements even though claims about the safety and effectiveness of these remedies are largely based on testimonials. If you're considering any alternative treatments or want to advise a friend or loved one with AD on alternatives, it's a good idea to discuss your interest with a health care professional (or suggest your friend talk to a health care professional) who can offer advice or discuss possible side effects. Some of the more widely known alternative treatments people with AD try include:

• Vitamin E: Vitamin E is sometimes prescribed for AD patients because it seems to help brain cells defend themselves against the damage caused by plaques and tangles. Research suggests that vitamin E supplements can help some people with AD, so discuss this option with your health care professional. However, vitamin E can cause negative side effects when used with other medications, such as blood thinners.

• Ginkgo biloba: This plant extract has been used for hundreds of years in China and is popular in Europe to help ease some neurological problems, including memory problems. It contains certain compounds that may have positive effects on cells within the brain. It is believed to be an antioxidant and may have some anti-inflammatory qualities, as well as the ability to help regulate neurotransmitters within the brain. One study found ginkgo biloba had a positive effect on patients with AD, although researchers cautioned the results were preliminary because of the limited number of participants. A large government-sponsored study is under way investigating whether ginkgo may help prevent or delay the onset of AD or vascular dementia in 3,000 participants.

• Huperazine A: This is a moss extract that has been used in traditional Chinese therapies for centuries. This extract is emerging as a potential treatment for AD because it contains certain properties similar to medical therapies already approved by the FDA, including donepezil and rivastigmine. However, huperazine A isn't regulated by the FDA and may not be manufactured under uniform standards. Health care professionals warn that people with AD shouldn't take this extract without medical consultation because it could interact with other medications.

Medicare Coverage for AD Expanded

Medicare, the government health insurance program for the elderly and disabled, provides coverage for some AD-related therapies. Specifically, the program:

• Cannot refuse to pay for any medical services for beneficiaries with AD solely because of their diagnosis.

• Covers evaluation and reasonable and necessary management visits by physicians or other health care providers for AD patients.

• Covers physical, occupational and speech therapy as needed for AD patients; however, coverage is limited.

• Covers psychotherapy or other behavior management therapy provided by a mental health provider for AD patients as needed under certain circumstances.

• Usually pays for home health care if the AD patient is homebound and requires a skilled service, such as nursing services or physical, occupational or speech therapy. Most home care for dementia, however, such as supervision and guidance during everyday activities, is not covered

Medicare does not pay for adult day care, 24-hour personal care in the home, assisted living facilities, or custodial care in nursing homes. However, Medicare does pay for medically necessary services such as physical, occupational and speech therapy, mental health services and hospice care.